From: Richard Cramer
To: Pharmacists
Sent: Tuesday, October 3, 2017 10:56:25 AM
Subject: Calcitonin Use

All, David wanted me to send out information on calcitonin inj. use.  We are using a lot more of this agent for inpatients than what we thought. The price several years ago was about $64/vial, it has increased over time to now $2,300/vial, if patient is getting it q 12 hr, that is close to $5,000/day.  Here are a few tips on controlling usage of the injection:

- Current formulary policy - if calcitonin is used for postmenopausal osteoporosis or Pagets disease, the injection should be interchanged to the nasal spray unless the patient cannot take the nasal spray.  The nasal spray is effective for these indications and is much less expensive.

- We do have a dose-rounding policy for the injection, in order to decrease waste if the dose requires only a small amount from an additional vial.

- FYI - Calcitonin is a last-line drug for osteoporosis.  For hypercalcemia, it should only be used in severe cases i.e. serum calcium over 14 and/or severely symptomatic.  Other options for treating mild-moderate cases are IV bisphosphonates, steroids, saline rehydration, loop diuretics.

- Let me know if you have any questions.   


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Richard Cramer, Pharm. D., FASHP, BCGP
Drug Information Coordinator